作者：丁宏举 ，周光 ，李明晖

单位：

1.266300山东省青岛市胶州中心医院急诊内科　2.266300山东省青岛市胶州中心医院康复科

Units：

1.Department of Emergency, Jiaozhou Central Hospital of Qingdao, Qingdao 266300, China 2.Department of Rehabilitation, Jiaozhou Central Hospital of Qingdao, Qingdao 266300, China

关键词：

缺血性卒中；替奈普酶；阿替普酶；替罗非班；疗效比较研究

Keywords：

Ischemic stroke; Tenecteplase; Ateplase; Tirofiban; Comparative effectiveness research

CLC：

R 743.3

DOI：

10.12114/j.issn.1008-5971.2023.00.308

Funds：

青岛市2020年度医药科研指导计划项目（2020-WJZD121）

摘要：

目的　比较替奈普酶与阿替普酶静脉溶栓联合替罗非班治疗急性缺血性脑卒中的临床疗效。方法　选 取2021年8月至2023年7月青岛市胶州中心医院急诊内科收治的 101例急性缺血性脑卒中患者为研究对象，采用随机数 字表法将其分为替奈普酶组（ n=51）与阿替普酶组（n=50）。替奈普酶组患者予以替奈普酶静脉溶栓联合替罗非班治 疗，阿替普酶组患者予以阿替普酶静脉溶栓联合替罗非班治疗。比较两组溶栓前和溶栓后1 h、24 h、7 d及出院时美国 国立卫生研究院卒中量表（NIHSS）评分，溶栓后7 d临床疗效，溶栓后90 d改良Rankin量表（mRS）评分和预后良好者 占比，溶栓后72 h内出血（症状性出血和颅内出血）发生率。结果　两组溶栓后1 h、24 h、7 d及出院时NIHSS评分分别 低于本组溶栓前，且替奈普酶组NIHSS评分低于阿替普酶组（P＜0.05）。两组溶栓后7 d临床疗效比较，差异无统计学 意义（P＞0.05）。溶栓后90 d，替奈普酶组mRS评分低于阿替普酶组，预后良好者占比高于阿替普酶组（P＜0.05）。 替奈普酶组出血发生率为2.0%（1/51），低于阿替普酶组的12.0%（6/50）（P＜0.05）。结论　替奈普酶与阿替普酶静 脉溶栓联合替罗非班治疗急性缺血性脑卒中的临床疗效相当，但与阿替普酶静脉溶栓联合替罗非班相比，替奈普酶静 脉溶栓联合替罗非班能更有效地减轻患者的神经功能缺损程度，改善患者预后，降低出血发生率，安全性更高。

Abstract：

Objective To compare the clinical efficacy of tirofiban and alteplase intravenous thrombolysis combined with tirofiban in the treatment of acute ischemic stroke. Methods A total of 101 patients with acute ischemic stroke admitted to the Department of Emergency, Jiaozhou Central Hospital of Qingdao from August 2021 to July 2023 were selected as the research objects. They were divided into tenecteplase group (n=51) and alteplase group (n=50) by random number table method. Patients in the tenecteplase group were treated with tenecteplase intravenous thrombolysis combined with tirofiban, and patients in the alteplase group were treated with alteplase intravenous thrombolysis combined with tirofiban. The National Institutes of Health Stroke Scale (NIHSS) scores before thrombolysis, at 1 h, 24 h and 7 d after thrombolysis and at discharge, the clinical efficacy at 7 d after thrombolysis, the modified Ranking Scale (mRS) score and the proportion of patients with good prognosis at 90 d after thrombolysis, and the incidence of hemorrhage (symptomatic hemorrhage and intracranial hemorrhage) within 72 h after thrombolysis were compared between the two groups. Results At 1 h, 24 h and 7 d after thrombolysis and at discharge, the NIHSS scores of the two groups were lower than those before thrombolysis, respectively, and the NIHSS scores of the tenecteplase group were lower than those of the alteplase group (P < 0.05) . There was no significant difference in clinical efficacy between the two groups at 7 days after thrombolysis (P > 0.05) . At 90 days after thrombolysis, the mRS score of the tenecteplase group was lower than that of the alteplase group, and the proportion of patients with good prognosis was higher than that of the alteplase group (P < 0.05) . The incidence of hemorrhage was 2.0 % (1/51) in the tenecteplase group, which was lower than 12.0% (6/50) in the alteplase group (P < 0.05) . Conclusion The clinical efficacy of tenecteplase and alteplase intravenous thrombolysis combined with tirofiban in the treatment of acute ischemic stroke is comparable. However, compared with alteplase intravenous thrombolysis combined with tirofiban, tenecteplase intravenous thrombolysis combined with tirofiban can more effectively reduce the degree of neurological deficit of patients, improve the prognosis, reduce the incidence of hemorrhage, and have higher safety.

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